Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
To prevent bleeding in hæmophilics, intra-venous or subcutaneous
injections of fresh blood serum, taken from the human subject, the
sheep, the dog, or the horse, have proved useful. If fresh serum is not
available, anti-diphtheritic or anti-tetanic serum or trade
preparations, such as hemoplastin, may be employed. We have removed the
appendix and amputated through the thigh in hæmophilic subjects without
excessive loss of blood after a course of fresh sheep's serum given by
the mouth over a period of several weeks.
The chloride and lactate of calcium, and extract of thymus gland have
been employed to increase the coagulability of the blood. The patient
should drink large quantities of milk, which also increases the
coagulability of the blood. Monro has observed remarkable results from
the hypodermic injection of emetin hydrochloride in ½-grain doses.
THROMBOSIS AND EMBOLISM
The processes known as thrombosis and embolism are so intimately
associated with the diseases of blood vessels that it is convenient to
define these terms in the first instance.
#Thrombosis.#--The term _thrombus_ is applied to a clot of blood formed
in the interior of the heart or of a blood vessel, and the process by
which such a clot forms is known as _thrombosis_. It would appear that
slowing or stagnation of the blood-stream, and interference with the
integrity of the lining membrane of the vessel wall, are the most
important factors determining the formation of the clot. Alterations in
the blood itself, such as occur, for example, in certain toxæmias, also
favour coagulation. When the thrombus is formed slowly, it consists of
white blood cells with a small proportion of fibrin, and, being
deposited in successive layers, has a distinctly laminated appearance on
section. It is known as a _white thrombus_ or laminated clot, and is
often met with in the sac of an aneurysm (Fig. 72). When rapidly formed
in a vessel in which the blood is almost stagnant--as, for example, in a
pouched varicose vein--the blood coagulates _en masse_, and the clot
consists of all the elements of the blood, constituting a _red thrombus_
(Fig. 66). Sometimes the thrombus is _mixed_--a red thrombus being
deposited on a white one, it may be in alternate layers.
When aseptic, a thrombus may become detached and be carried off in the
blood-stream as an embolus; it may become organised; or it may
degenerate and undergo calcification. Occasionally a small thrombus
situated behind a valve in a varicose vein or in the terminal end of a
dilated vein--for example in a pile--undergoes calcification, and is
then spoken of as a _phlebolith_; it gives a shadow with the X-rays.
When infected with pyogenic bacteria, the thrombus becomes converted
into pus and a localised abscess forms; or portions of the thrombus may
be carried as emboli in the circulation to distant parts, where they
give rise to secondary foci of suppuration--pyæmic abscesses.
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